Antibiotics sDon’t use vancomycin or carbapenems empirically for neonatal intensive care patients unless an infant is known to have a specific risk for pathogens resistant to narrower-spectrum agents.

Rationale and Comments

Antibiotics such as vancomycin and carbapenems are active against highly-antibiotic resistant bacteria unresponsive to other antibiotics. Overuse of these antibiotics can exert selection pressure and promote colonization and infection with increasingly resistant organisms, raising the specter of morbidity and mortality due to untreatable infection. Vancomycin in particular is commonly used as a first-line choice when infection is suspected in the newborn intensive care unit, despite evidence that there is no survival benefit attributed to empiric therapy for most infected infants. Guidelines have been developed that can safely limit the empiric use of vancomycin to those infants known to be colonized with MRSA.

Sponsoring Organizations

American Academy of Pediatrics – Committee on Infectious Diseases and the Pediatric Infectious Diseases Society

Sources

Cohort studies

Disciplines

Infectious disease
Neonatology

References

Hsieh EM, Hornik CP, Clark RH, Laughon MM, Benjamin DK Jr, Smith PB; Best Pharmaceuticals for Children Act Pediatric Trials Network. Medication use in the neonatal intensive care unit. Am J Perinatol. 2014;31(9):811-821.
Ericson JE, Thaden J, Cross HR, Clark RH, Fowler VG Jr, Benjamin DK Jr, Cohen-Wolkowiez M, Hornik CP, Smith PB; Antibacterial Resistance Leadership Group. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J. 2015;34(4):371-375.
Thaden JT, Ericson JE, Cross H, Bergin SP, Messina JA, Fowler VG Jr, Benjamin DK Jr, Clark RH, Hornik CP, Smith PB; Antibacterial Resistance Leadership Group. Survival Benefit of Empirical Therapy for Staphylococcus aureus Bloodstream Infections in Infants. Pediatr Infect Dis J. 2015;34(11):1175-1179.
Chiu CH, Michelow IC, Cronin J, Ringer SA, Ferris TG, Puopolo KM. Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit. Pediatr Infect Dis J. 2011;30(4):273-278.
Holzmann-Pazgal G, Khan AM, Northrup TF, Domonoske C, Eichenwald EC. Decreasing vancomycin utilization in a neonatal intensive care unit. Am J Infect Control. 2015;43(11):1255-1257.